Should You Use A “Waist Trainer” Post-Pregnancy?

Should you use a "waist trainer" post-pregnancy? New Heights Physical Therapy in Vancouver WA and Portland OR.

Short Answer: No.

In recent years, “waist training” post-pregnancy has dramatically increased in popularity. Often promoted by business-savvy celebrities who conveniently have their own line of these devices, waist trainers are said to undo the problematic changes to a woman’s body that occur during pregnancy. The advertised benefits of waist trainers include a narrower waistline, improved posture, toned abdominals, healing of a diastasis recti, and correctly repositioned internal organs. Sounds great, but are these claims too good to be true?

While being worn, a waist trainer can certainly create a smaller waistline and improved posture. This is hardly surprising – corsets have been used for these purposes for centuries. However, the additional claimed benefits of these devices are simply not achievable through this passive “training”. More importantly, using a waist trainer is not necessarily benign – it can actually worsen some of the problems it claims to fix by interfering with the normal function of the core muscles. With a small amount of relevant anatomical knowledge, women can avoid this trend and choose more effective measures for regaining strength, function, and fitness post-pregnancy.

The Abdominal Muscles

The abdominal muscles are a large, complex muscle group that runs from the ribcage to the front of the pelvis and pubic bone. During pregnancy, the abdominal muscles stretch, the base of the ribcage expands, and the pelvis tilts downward in order to accommodate the growing baby. Abdominal laxity and postural changes can persist post-pregnancy, leading to dysfunction and discomfort. So, why not forcefully corset the body back to its original shape? Problem solved, right? Wrong. Prolonged bracing of any muscle in a contracted position will not make it stronger. Over time, the body will learn to rely on the external support of the brace instead of the internal support provided by its own muscular system. For this reason, wearing a waist trainer will actually result in weaker abdominals and undermine autonomous healthy posture in the long run. If a person had weak biceps, we would never recommend bracing their arm into an uncomfortable and restrictive device in order to strengthen and tone the biceps. Why are postpartum women being told to do this with their midsections? Rather, through progressive strengthening of core musculature, a full abdominal contraction can be developed which automatically narrows the base of the ribcage and lifts the front of the pelvis. In this way, abdominal tone and balanced posture are naturally restored.

What About Healing A Diastasis Recti?

The term diastasis recti refers to the thinning and widening of the fibrous connective tissue that separates the right and left halves of the abdominal muscles. This connective tissue, known as the linea alba, runs down the front of the body from the ribcage to the pubic bone. During pregnancy, the linea alba is stretched along with the rest of the abdominals. After months of being stretched, the abdominals often have difficulty fully contracting and the space between them can widen. This leads some women to notice gap between the two sides of their abdominal muscles which can persist post-pregnancy. The fact is that any muscle group placed in a continuously stretched position for months at a time would have some difficulty contracting post-stretch. If you held a hamstring stretch for several months you would end up with a lengthened hamstring that didn’t remember how to bend your knee. Please don’t try this experiment at home!

There will be some natural shrinking of a diastasis recti in the months post pregnancy, but a waist trainer is unlikely to assist in this process. If you sustain a bad cut, it makes sense to have the two sides stitched together to allow proper healing. But a diastasis recti is not a tear or cut whose sides need to be held together in order to heal. A diastasis recti is a symptom of abdominal weakness that results from the stretching of abdominal muscles and their connective tissue during pregnancy. The only thing that can eliminate a diastasis recti is to train the abdominals to fully contract again.

Can A Waist Trainer Help Reposition The Internal Organs Post Pregnancy?

The answer to this one is yes – but unfortunately not in a good way. As the abdominal muscles contract, the internal organs and the muscles of the pelvic floor lift up towards the ribcage. This action mobilizes and strengthens the pelvic floor. A waist trainer will impede normal abdominal contraction and prevent this lift. Instead, the waist trainer will apply a downward pressure to the viscera and the pelvic floor, which can have problematic effects. Imagine tying a string around a balloon: the displaced air will increase pressure and stretch on either side of the string. In the same way, the increased pressure exerted by a waist trainer can stretch and weaken the pelvic floor musculature, contributing to urinary incontinence and pelvic organ prolapse.
In conclusion, scrap the waist trainer in favor of progressive core strengthening. Muscles can return to what they were designed to do without the help of this device.

Pregnancy Related Low Back and Pelvic Pain

By: Gema Sanchez, PT

Prevalence of low back and pelvic pain during pregnancy has been estimated to be as high as 90%. It is so common that many obstetricians consider it a normal finding in pregnancy. Many women also consider pain to be an inevitable and normal part of pregnancy and do not seek treatment, despite significant limitations in day to day activities. As many as 80% of pregnant women report that back pain affects daily activities such as walking, rolling over in bed, getting out of a chair and getting out of bed.

Low back and pelvic pain during pregnancy also has significant repercussions post-partum. Risk of return of pain in a subsequent pregnancy has been estimated at 85%. One study found 20% of women with back pain during pregnancy reported residual pain three years later and 10% of women with chronic low back pain link the onset of their pain to pregnancy. This is unfortunate, since several studies have shown that simple interventions for pain during pregnancy such as exercise, education and manual therapy techniques can significantly improve pain and function during pregnancy and prevent persisting and chronic pain post-partum.

Exercise combined with education (in anatomy and physiology, posture, pain, normal pelvic changes, self help management, ADL modifications) has been found to be an effective treatment for pregnancy related lumbar, pelvic, and symphysis pubis pain. In 2014, Van Benten et al reviewed 22 randomized controlled trials on the effectiveness of physical therapy interventions in treating lumbopelvic pain during pregnancy.  They concluded that exercise combined with education had a positive effect on pain, disability and/or sick leave. In one of the reviewed studies, Shim et al provided education and an exercise program to a group of 56 women with pregnancy related lumbar and pelvic pain. After 12 weeks, the women in the intervention group reported an almost three point decrease in pain. Education and exercise were also provided to late pregnancy subjects with symphysis pubis pain and dysfunction in the study by Depledge, et al. They found that after only one week of education and exercise, average pain decreased by 31.8% and disability decreased by 38.6%.

Osteopathic manual techniques, practiced by osteopathic physicians and physical therapists, have also been shown to be effective for pregnancy related back pain. Licciardone et al compared the effect of the addition of 5-7 sessions of osteopathic manual techniques (soft tissue, myofascial release, muscle energy and range of motion mobilization) to usual obstetric care in 146 women with late pregnancy back pain. They found that back pain decreased and back specific functioning deteriorated less in those women who received the manual techniques.

Low back pain, pelvic pain and functional limitations because of pain should not be considered an inevitable or normal part of pregnancy. Intervention during pregnancy can decrease pain, improve function and reduce the risk of persisting and chronic pain. Physical therapy at New Heights Physical Therapy Plus provides safe and effective customized assessments and interventions in all stages of pregnancy and post-partum.

In June, we will be welcoming a new physical therapist, Julie Burtis. Julie specializes in women’s health and will be splitting her time between the West and East clinics. She will be giving a lecture on Postpartum Rehab at New Heights (East Clinic) on June 29th from 6-7PM.